title: Closure of midline laparotomies by means of small stitches: practical aspects of a new technique.
abstract: Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC). A structured implementation of the technique had been performed at SH but not at EMC. Personnel were interviewed by questionnaire. At each hospital, 18 closures were analyzed. Closure time was significantly longer (p = 0.023) at SH (median 18 minutes, range: 9-59) than at EMC (median 13 minutes, range: 5-23). An SL:WL ratio of more than 4 was achieved in 8 of 18 cases at EMC and in all 18 cases at SH. We conclude that calculation of an SL:WL ratio is easily performed. Suturing with the small bite-short stitch interval technique of SH required 5 minutes extra, outweighing the morbidity of incisional hernia. Without a structured implementation to suture with an SL:WL ratio of more than 4, a lower ratio is often achieved.
authors.affiliation: Department of Surgery Erasmus University Medical Center Rotterdam, Netherlands.
authors.forename: Gabriëlle H
authors.initials: GH
authors.lastname: van Ramshorst
authors.affiliation: Department of Surgery Erasmus University Medical Center Rotterdam, Netherlands.
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Klop
authors.affiliation: Department of Biostatistics Erasmus University Medical Center Rotterdam, Netherlands.
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.affiliation: Department of Surgery and Perioperative Science Umeå University Umeå, Sweden.
authors.forename: Leif A
authors.initials: LA
authors.lastname: Israelsson
authors.affiliation: Department of Surgery Erasmus University Medical Center Rotterdam, Netherlands.
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D005260:Female; D006801:Humans; D007813:Laparotomy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D061646:Operative Time; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013548:Sweden; D016896:Treatment Outcome